Steve Wolf MD: Many families ask is there a possible diet that we could use to stop the seizures? And really there's two different diets. One is the ketogenic diet, which is basically a high-fat, no-carb, low-protein diet. And then there's the modified Atkins diet, which is again no carbs, but with protein and fats.
Patty McGoldrick NP, MPA: Now the thing with the ketogenic diet and even with the modified Atkins is that they're not as safe and easy to implement as people think. They're difficult to follow. The foods are high-fat. There's no carbs, so there's no fruit. There's no vegetables. The food has to be weighed. The parents have to check the child's urine to make sure that they're in ketosis. It's actually best used for people who are still on formula or people who have gastrostomy feeds. And then it's a good option, especially in certain kinds of epilepsy.
Steve: It might sound difficult to do it, which it is. You need to work with your nutritionist to find the right diet, as well as to work with your neurologist to find our whether you really are a good candidate for the ketogenic diet, as Patty was mentioning. But what's interesting about this is when you are on these diets, and you have to be very strict when you're on the diet, it changes the way your body breaks down food to make energy for your brain. So by eliminating carbohydrates, it eliminates certain byproducts of carbohydrates that might be causing seizures and only letting your body break down fats and proteins, which really the results show that it does control seizures very effectively.
Patty: In addition to monitoring the urine, you also have to monitor weight loss. It can cause weight loss. And it can be difficult if you have a young child or a school-age child who's on the diet, because it limits social interaction, again because they can't eat out. They have to weigh and measure the food. But it is a good choice for people with intractable epilepsy. It's not really a first-line treatment, though.
Steve: So the take-home message is there are diets for epilepsy, especially very difficult to control epilepsies. It's important to have a nutritionist to work with you and a neurologist to find what is the right diet for you. There are many things that need to be monitored during the diet, but it can be a very effective treatment in the care of patients with very difficult to control epilepsy.